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6-Clinical Nutrition 1 > Hypertension Part 2 > Flashcards

Hypertension Part 2 Flashcards

1
Q

How does exercise affect HTN by numbers?

A
  • regular moderate P.A. of at least 30 min/day on most days: reduced BP by 4-9 mmHg independently from weight loss.
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2
Q

How does increasing physical activity decrease HTN?

A
  • decrease the relative workload on the heart: benefit for all CVD
  • may help reduce weight
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3
Q

Is resistance exercise benefit HTN?

A

resistance exercise does not negatively impact BP

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4
Q

How is the nutrition assessment done for HTN?

A
  • identify dietary factors and patterns
  • evaluate need for weight control
  • prioritize methods to meet DASH dietary goals
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5
Q

What are the diagnosis can be made in terms of nutrition therapy for HTN?

A
  • excessive energy intake
  • excessive or inappropriate intake of fats
  • excessive Na intake
  • Inadequate Ca, Fiber, K, or Mg intake
  • Overweight/obesity
  • Food nutrition knowledge deficit
  • Physical inactivity
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6
Q

What are the nutrition interventions that need to be considered for therapy for HTN?

A
  • comprehensive approach that addresses multiple lifestyle factors
  • DASH
  • Weight loss
  • Alcohol
  • K, Ca, Mg
  • Physical activity
  • Smoking cessation
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7
Q

What is the DASH diet?

A

Dietary approaches to stop HTN

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8
Q

What is the rationale behind the DASH diet?

A

Negative correlations between blood pressure and certain nutrients intake (Mg, K, Ca, Fibers, Proteins)

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9
Q

What were the three diets that were compared in the first study done on HTN in 1997?

A
  • control diet: poor in Ca, Mg, and K
  • Rich in veg & fruits diet (high in K, Mg, and Fibers)
  • Mixed diet: DASH diet, rich in veg and fruits, legumes and low-fat dairy (high K, Mg, Ca, fiber and poor in total fat, SFA, and dietary cholesterol)

** 3mg sodium in all

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10
Q

What are the benefits of the DASH diet in terms of numbers?

A
  • decrease in systolic BP by 5.5 mmHg and diastolic BP by 3.0 mmHg in all participants
  • further decrease in hypertensive subjects: -11.4 mmHg/5.5 mmHg
  • Half of these effects were observed for high fruits and vegetable diet
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11
Q

What is the DASH sodium diet?

A

in 2001, DASH sodium: 1500mg Na diet combines with DASH diet, recommended when refractory HTN –> greater combined effects on BP

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12
Q

What is the percentage of carbs recommended in DASH diet?

A

55%

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13
Q

What is the percentage of protein recommended in DASH diet?

A

18%

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14
Q

What is the percentage of fat recommended in DASH diet?

A

27% (6% saturated fat)

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15
Q

What is the OmniHeart Study?

A

3 diets similar to DASH-sodium were compared in prehypertensive and hypertensive adults:

  • rich in CHO
  • rich in PRO
  • mediterranean like (rich in unsat fat.)
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16
Q

What were the results in the OmniHeart Study?

A
  • all reduced blood pressure, LDL-C and CV risk

- high in PRO and unsat. fa. further decreased BP in hypertensive ppl

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17
Q

What are the major sources of energy and fiber in DASH diet?

A

whole wheat bread and rolls, whole wheat pasta, english muffin, pita bread, bagel, cereals, oatmeal, brown rice

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18
Q

What are the rich sources of potassium, magnesium and fiber in DASH diet?

A

broccoli, carrots, collards, green beans, green peas, kale, lima beans, potatoes, spinach, squash, sweet potatoes, tomatoes

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19
Q

What are the important sources of potassium, magnesium and fiber in DASH diet?

A

apples, apricots, bananas, dates, grapes, oranges, grapefruit, grapefruit juice, mangoes, melons, peaches, pineapple, raisins, strawberries, tangerines

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20
Q

What are the major sources of calcium and protein in DASH diet?

A

low fat dairy

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21
Q

What are the rich sources of protein and magnesium in DASH diet?

A

select only; lean trim away visible fats, broil roast, or poach; remove extra skin from poultry

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22
Q

What are the rich sources of energy, protein, fiber and magnesium in DASH diet?

A

nuts, seeds, nut butters, kidney beans, lentils, split beans

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23
Q

Where does the 27% fat should come from in DASH diet?

A

soft margarine, veg oil, low fat mayonnaise, light salad dressing

24
Q

What is the condition in sweets in DASH diet? Give examples

A

sweets should be low fat

fruit flavored gelatin, fruit punch, hard candy, jelly, maple syrup, sorbet and ices, sugar

25
Q

What is the BOLD Study?

A
  • done in healthy adults
  • comparison of US diet, DASH diet, DASH-like with lean beef (BOLD), DASH-like with lean beed and additional protein (BOLD+)
26
Q

What is the Higher-Fat DASH Study?

A
  • in healthy adults
  • comparison of control diet, typical DASH diet and higher-fat/low CHO DASH diet
  • Higher-fat/low CHO DASH diet vs DASH diet
27
Q

What were the results of the BOLD Study?

A
  • similar reduction in total cholesterol, LDL-C, HDL-C, in BOLD, BOLD+, and DASH diet
28
Q

What were the results of the Higher-Fat DASH Study?

A
  • similar reduction in BP
  • decreased TG and large medium VLDL particle concentrations
  • increased LDL peak particle diameter (beneficial effects)
29
Q

What are the indications for drug treatment in HTN?

A
  1. should be prescribed or average DBP>100 or avg. SBP>160 mmHg in pt without macrovascular target organ damage or other CVD risk factors
  2. should strongly considered if:
    - avg. DBP > 90 or
    - avg. SBP > 140 mmHg
    in presence of macrovascular target organ damage or CVD risk factors - regardless of age
  3. in the very elderly (>80yrs) who do not have diabetes or target organ damage, the SBP threshold for initiating drug therapy >160mmHg
30
Q

What are antihypertensive drugs?

A
  • Thiazide diuretics
  • Distal tubular diuretics
  • Beta blockers
  • Angiotensin converting enzyme (ACE) inhibitors
  • Calcium channel blockers
  • Angiotensin II Receptor Blockers
31
Q

What are the treatment goals with patients and patients with extra diabetes or renal disease?

A

SBP < 140mmHg
DBP < 90mmHg

Diabetes and renal disease:
SBP < 130mmHg
DBP < 80mmHg

32
Q

What are the considerations in prescribing the right drug?

A
  • location of the drug metabolism and excretion (liver adn kidney)
  • drug/nutrient interactions
  • with ALL drugs AVOID natural licorice
  • nutritional status (ex. low albumin may increase drug effect bc of more free drug in the blood)
  • physiological state (ex. pregnancy, lactation, presence of other disease)
33
Q

What are the complicated situations in HTN drug use and which drug should be used in those cases?

A
  • Diabetes
    (ACEi or ARB; CCB or diuretics in absence of macro- and micro- albuminemia)
  • Coronary Heart Disease
    (ACEi or ARB; B-blockers or CCB for stable angina)
  • Heart Failure
    (ACEi or ARB + B-blockers)
34
Q

What is the problem with micro or macro albuminemia in terms of HTN medications?

A

more leakage of albumin in the kidney means that there is an alteration of the kidney function and so the doctor will not prescribe diuretics to these people

35
Q

What is the mechanism of loop and thiazide drugs (K-losing)?

A
  • decreased reabsorption of Na and K
  • reduction of osmotic diuresis
  • increased excretion of Na and K (and H+)
36
Q

What is the mechanism of K sparing drugs?

A

inhibits action of aldosterone

37
Q

What is the generic name for loops diuretics (K-losing)?

A

furosemide (Lasix)

38
Q

What is the generic name for thiazides (K-losing)?

A

hydrochlorothiazide (Apo-Hydro)

39
Q

What are the side effects of loops diuretics (K-losing)?

A

hypokalemia, anorexia, N/V, constipation

- K supplements recommended

40
Q

What are the side effects of thiazides (K-losing)?

A

hypokalemia, hypoglycemia, anorexia, malaise, muscle weakness

41
Q

What are the considerations for loop diuretics and thiazides in terms of nutrition?

A
  • provide K rich foods
  • provide K supplements
  • increased risk for ulceration, N/V/D
42
Q

What is the generic name for K-sparing?

A

spironolactone (Aldactone)
thiamterene
amiloride

43
Q

What are the considerations for K-sparing drugs in terms of nutrition?

A
  • avoid excess dietary K and K supplements
  • avoid salt substitutes
  • avoid excess water consumption
  • take with food
  • avoid natural licorice
44
Q

What is the generic name for Ace Inhibitors?

A

ramipril (Altace)

45
Q

What is the mechanism of Ace inhibitors?

A

inhibit conversion of angiotensin I to angiotensin II

–> decrease vasoconstriction, ADH, inhibits aldosterone release

46
Q

What are the side effects and interactions of Ace inhibitors?

A
  • hypotension, dry cough, may worsen renal function, hyperkalemia
  • side effects are increased in African Americans
  • avoid salt substitutes
  • avoid natural licorice
47
Q

What is the generic name for Angiotensin II Receptor Blockers (ARB)?

A

Valsartan (Diovan), losartan (cozaar)

48
Q

When should ARB used?

A

usually used when ACEi are not tolerated

49
Q

What is the mechanism of ARB?

A

block angiotensin II receptor and therefore decreases its activity –> vasodilation, reduced vasopressin and aldosterone

50
Q

What are the side effects and interactions of ARB?

A
  • hyperkalemia, nausea, dizziness
  • avoid salt substitutes
  • avoid licorice
  • caution with grapefruit
51
Q

What is the generic name for Calcium channel blockers?

A

amlodipine (Norvasc)

52
Q

What is the mechanism of CCB?

A

affect the movement of Ca through Ca channels causing blood vessel relaxation (especially large vessels)

53
Q

What are the side effects and interactions of CCB?

A
  • edema, nausea, heartburn
  • avoid natural licorice
  • limit caffeine
  • limit or avoid alcohol
  • avoid grapefruit with felodipine (plendil)
54
Q

What is the contraindication of CCB?

A

Heart failure

55
Q

What is the generic name for B-blockers?

A

propanolol (inderal), atenolol, metoprolol

56
Q

What is the mechanism of B blockers?

A

block adrenergic beta-receptors in the heart (BI)
–> decrease rate and cardiac output
block epinephrine

57
Q

What are the side effects and interactions of B-blockers?

A
  • N/V, constipation/diarrhea, bloating, marks symptoms of hypoglycemia (caution w/DM), dizziness, fatigue, CHF, hallucinations, insomnia
  • avoid natural licorice
  • beta blockers are not recommended as intial therapy in those over 60 years of age.

6-Clinical Nutrition 1 (21 decks)

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